Provider Demographics
NPI:1194977900
Name:STIERMAN, MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STIERMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 ROACHTON RD # 1
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1350
Mailing Address - Country:US
Mailing Address - Phone:419-872-0777
Mailing Address - Fax:419-872-2369
Practice Address - Street 1:12780 ROACHTON RD # 1
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1350
Practice Address - Country:US
Practice Address - Phone:419-872-0777
Practice Address - Fax:419-872-2369
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10338-NP363L00000X
OHCOA10338-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2905495Medicaid
OHNP29381Medicare PIN